Provider Demographics
NPI:1437793775
Name:INTEGRATED DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:INTEGRATED DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NAUMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NISAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:712-389-5242
Mailing Address - Street 1:425 BAYHILL CIR
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5092
Mailing Address - Country:US
Mailing Address - Phone:712-389-5242
Mailing Address - Fax:
Practice Address - Street 1:201 E 4TH ST STE 203
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-1706
Practice Address - Country:US
Practice Address - Phone:712-389-5242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty